scallywag

Scallywag: Cymbalta - skipping doses didn't work, time to taper

196 posts in this topic

I started on Cymbalta 60 mg 4 years ago, (after 1-2 weeks @ 30 mg); the scrip was from a psychiatrist for major depressive disorder.  My depression lifted significantly. After 1 year (+/-) the psychiatrist and I agreed that my family practitioner would handle the prescription and supervision.

 

I was ready to go off the cymbalta and was planning to go of the meds until a couple of deaths close to me occurred. I agreed with my doc that it wasn't the time to make changes in the meds.

 

About 15 years ago I was on Effexor XR and had a helluva time getting off it, even with bead counting. After having read the slow pace recommended here, I probably decreased too quickly.  I remember the roller-coaster ride of symptoms (physical, emotional, and cognitive) but forgot about the bead counting. When I started both Effexor & Cymbalta, I had nausea for a couple of days.

 

On my FP's advice, I started going off cymbalta in Feb. by taking 30 mg every other day for a few weeks, then every 3 days, etc.  This last week I was starting with 30 mg every 4 days. Fortunately I was using a calendar reminder in my google calendar to keep the schedule.  I say fortunately because on Tuesday I had nausea and on Saturday.  When I looked at my calendar to mark the reminder as "done," I realized that the nausea was probably related to the cymbalta.  Now that I think of it, I started having disrupted sleep and messed-up wake/sleep cycles in March.

 

A web search (DuckDuckGo instead of the big G) led me here and reminded me that slow tapering and counting the granules worked better for me before. 

 

My plan now:  I have 6 capsules leftover from 60 mg doses.  I'll split each into 3 doses, approx. 20 mg, and try 20 mg/day for 18 days (to use them up), making adjustments if necessary.  Based on how that goes, I'll either continue at 20 mg or start a 10% taper to 18 mg over 28-30 days.

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Hey scallywag and welcome to SA.

 

I've been in your shoes, and recently I might add, but I was trying to switch to Viibryd from Cymbalta. It did not go well. Reinstatement of Cymbalta at a lower dose worked for me, I hope it works for you too! I'll leave the more detailed stuff for the mods, who should be along shortly.

 

Just wanted to stop by and welcome you to SA and let you know I'm in a similar situation if you want to talk or commiserate sometime!

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Hello scallywag (love the name btw),

 

So glad you found your way here.  Hopefully you can get yourself out of the rocky patch caused by skipping doses - we have a lot of good info on how to taper smoothly and gently.  Alternating doses is a bit like playing ping-pong with your brain - ouch!  Your Central Nervous System can get really destabilised, and that can make any future tapering more difficult.

 

It sounds like you've read about our recommended gentle taper, reducing by no more than 10% of your current dose each month.  This allows your brain time to adjust as you go, and lessens any withdrawal.  For now, your idea of holding steady at 20mg is probably a good one, as it will give you a chance to stabilise before further tapering.

 

Tips for Tapering Cymbalta has a lot of practical info.  Are you on brand-name Cymbalta with the hundreds of little beads in each capsule or is it a capsule with only a few larger pellet type things?  The former is easier to taper with, but there are instructions here for each type.

 

Many people find Fish oil and Magnesium useful during withdrawal.   

 

Thanks for writing a signature.  If you could add more detail about how you are tapering, this will aid anyone who is helping you down the track.

 

Have a read of those and then you can come back to this thread to discuss things further.  This can be your journal to record your tapering and healing progress, and to ask questions.

 

Welcome to s/a,

Karen

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Hey scallywag and welcome to SA.... Just wanted to stop by and welcome you to SA and let you know I'm in a similar situation if you want to talk or commiserate sometime!

 

Thanks purcy!  It's good to know you're out there.

 

... For now, your idea of holding steady at 20mg is probably a good one, as it will give you a chance to stabilise before further tapering.

... Tips for Tapering Cymbalta has a lot of practical info.  Are you on brand-name Cymbalta with the hundreds of little beads in each capsule or is it a capsule with only a few larger pellet type things?  The former is easier to taper with, but there are instructions here for each type.

... Many people find Fish oil and Magnesium useful during withdrawal.   

... Thanks for writing a signature.  If you could add more detail about how you are tapering, this will aid anyone who is helping you down the track.

 

Hi Karen! Thanks for your encouragement about my plan -- nice to have that. :)  I have read the Cymbalta thread you linked as well as the fish oil and magnesium threads.  I've modified my signature to show that I've been taking those supplements (and others) as well as indicating that I use the brand name Cymbalta capsules.

 

I'll definitely be updating this post as I go.

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Day 1 (yesterday) @ 20 mg, no nausea.  Cause could be either the lower dose or the decrease in days between doses. Either way, it works.

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Day 2 isn't finished yet, however, I notice a difference after a second dose of 20 mg: No nausea and I actually caught myself tidying. :o

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Day 3 has gone well.  It feels good to have mind-body confirmation about reinstating the cymbalta.

 

I've spent a fair amount of time in the last 2 days reading the forums. In reading threads in the Symptoms & self-care forum, I found myself thinking about adding the supplements, doing the meditations, yoga poses, etc.  And, of course, the thought was  "must start ALL of them right now! :wacko:  I'm grateful that I can hear the perfectionism in that siren's call. 

 

I worked with a naturopath who specializes in treating neuro-psychiatric conditions. The protocol was quite demanding: supplement combinations before and during meals and before bed (different ones each time); dietary changes. I think there was a cleanse/detox in there at some point too. It was too much work for my tired brain to figure out from the somewhat-chaotic instructions, let alone manage every day. My mind & body responded well but after about 6 weeks the effects gathered momentum and I couldn't "white-knuckle" my way through any longer. It felt like it was too much, too fast and, for lack of a better expression, I crashed. 

 

With that experience and my too-fast-therefore-difficult detox from Effexor in 2004/5, I know I need to take things slowly, to be gentle with myself.  But oh goodness, the thoughts to DIA-DIN (do it all, do it now) are frequent, loud, and tempting.

 

I may need to stay away from the Symptoms forum until I have an actual symptom that interferes with my life. B)

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More reading of the forums leads me to provide more detail about my history, skip-a-dose "taper" and the symptoms I've experienced while skipping doses.

 

After my coping mechanisms were wearing thin in the 13th months of extreme stress and chaos, I started 60 mg cymbalta to treat major depressive disorder (MDD). I was on leave from work at the time. In the initial stages of the MDD, a successful day meant that I moved from my bed to the sofa. I did drag myself out for support -- an individual therapist weekly, and 2 support groups.  My range gradually expanded. I remember one day waking up happy about 2 months after starting the cymbalta. I went back to work about 2 weeks after that in the hope that I could keep one major part of my life stable.

 

Upon returning to the job I had difficulty concentrating, shifted sleep cycles staying up and getting up later and later, facial twitching (noticed by a co-worker), a sense of feeling lost and as if I'd lost my place. Within a couple of months, I didn't improve and was let go. Yahoo -- more stress and chaos.

 

2013: still on 60 mg cymbalta, prescribing psychiatrist says: (1) I'm stable; (2) my GP can continue to prescribe; and, (3) GP can re-refer me if I want his supervision for discontinuation. [just remembered that now, maybe this forgetting is a cognitive symptom of w/d?]

 

2014, 2015: I continue with 60 mg cymbalta daily. Late in 2015 I miss a dose every now and then and notice no symptoms. So I skip a dose every other day intentionally.

 

Fast forward to January 2016, my GP is on leave. I talk with replacement doc from the same practice about reducing my cymbalta dose to 30 mg, saying I have been intentionally dosing every day with no noticeable symptoms. I ask about a prozac bridge (mentioned to me when I discussed discontinuation problems with the psychiatrist); replacement doc says there's no problems with cymbalta and that I can switch to 30 mg/day then every other day, then increasing time between doses.

 

I fill the prescription for 30 mg in mid-Feb. I don't remember when I started the daily 30mg however I see that I've used 18 capsules. Best guess is the end of February. It appears that I aggressively reduced considering that at 1/day I'd use 28 in a month. 

 

My symptoms by late March: not feeling tired at night therefore staying up later and later, relentless rumination about a recent event, reduced appetite, avoiding social contact, rarely motivated to do even the bare minimum (shower, buy groceries). 

 

Writing this out makes me wonder: Is this withdrawal or relapse? Does it matter which it is?

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If getting off drugs is what you feel is important, then it really doesn't matter whether it's withdrawal or relapse.  You just keep tapering gently, and do what you can to take care of yourself.  (I love what you say in your previous post about avoiding the symptoms threads for now...)

 

However, it is more than likely to be w/d.  It is so common for people to mistake w/d for relapse, and it's a major reason they end up back on drugs.  Skipping doses is a sure way of destabilising your Central Nervous System, and while you may not have noticed symptoms at first, the effects build up cumulatively, causing the issues you are feeling now.  All of the current symptoms you list are very common in w/d. 

 

Are things still improving with the regular daily dosing?

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KarenB - thanks for your comments.  You're right that it doesn't matter whether the symptoms I was having were the result of relapse or withdrawal.

 

I've followed a few of the self-care threads in the Symptoms forum/board so I can jump to them directly. ;)

 

DAY 5 UPDATE ON 20 mg

The daily dosing seems to have stabilized me and my CNS.  I have yet to reset my wake/sleep cycle to something workable.

 

Tapering - counting beads for doses

Today I called a compounding pharmacy that's within 2 km of my home. Unfortunately they can't help me with my already purchased capsules, as I suspected.  I understand the reasons (safety, professional accountability, profit) but it is disappointing.

 

That got me thinking though about how to manage the next doses changes. With close to 600 beads in my 60 mg capsules, I don't want to be fiddling with that all the time.  I've decided I'll use capsules that contain a multiple of 5 mg, then a second special capsule to top of the dose to the 10% taper amount. I think it might be easier *for me* than trying to count/weigh the exact taper dose. For example:

  • 20.0 = 20 +0
  • 18.0 = 15 +3
  • 16.2 = 15 + 1.2
  • 14.6 = 10 + 4.5 or 15 - 0.4
  • 13.2 = 10 + 3.2

 

... until I've used up enough of my capsules (60 mg and 30 mg) to justify going to the compounding pharmacy. After discussing my tapering plan with my doctor, I'll get a prescription filled at the compounding pharmacy and ask them to make me 10 mg caps and 5 mg caps. At some (much later) time may ask for 2 mg and 1 mg caps.

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Right now I'm wishing Brassmonkey hadn't gone on holiday, cause he's our maths/figuring whiz.  It sounds a really good idea, the only thing I'm unsure about is how you'll measure the extra amount you add to each lot of full capsules?  I mean, how do you know what +3 is?  (Boy, I'm possibly showing up my limited maths ability here :blush: - so if you've got it figured, just go ahead and ignore me). 

 

I just wasn't sure if it takes into consideration that the actual weight of each capsule is different from the dosage weight (because there is filler in each little bead in the capsules), and also that each capsule itself can vary in weight (the manufacturers are quite inaccurate).   

 

An option many of us use is micro scales, such as the Gemini-20, and weighing our doses out.  Once you get used to calibrating the scale it's quite precise. 

 

Really glad things have stabilised for you.  Sleep patterns do often seem to take longer for people, unfortunately. 

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Karen, Thank you for your thoughtful response.  I'm more than okay with doing the arithmetic, although I use Excel spreadsheets rather than doing it in my head.

 

Right now I open 1 capsule, set up 3 bowls then count out 5 or 10 beads for each bowl, repeat until there's a small number left. When I get to the end I divide them as evenly as I can. For 15 mg "base doses" I'll just set up 4 bowls.  I can do the same for smaller doses: Calculating the 3 mg isn't really a problem.  60 ÷ 3 = 20, 30 ÷ 3 = 10. I'll probably use my 30 mg caps to get the 3 mg. I could use the 30 mg caps to count 20 approximate 1.5 mg doses.  In the near term I can do a 10% cut to 18 mg, then for simplicity a 1.5 mg (<10%) cut to 16.5, then another 1.5mg cut to 15, and another 1.5mg (10%) to 13.5mg.  After that it's a little not as easy, maybe using 1 or 1.2 mg. I'm not going to spend too much energy on it now as I've got a couple months to noodle it through.

 

I had hoped weighing would be an option and have looked at the scale you mentioned.  I posted in that thread today about some potential issues with it in terms of providing consistent measurements. Here's the post

 

 

Update on 20 mg dose:

Took it today in applesauce again.  Taking it with applesauce eliminates one fiddly task for me for now, that of pouring beads back into a capsule.  For that task, a friend suggested a seed dispenser that's used for very small seeds, such as carrot and radish seeds. Here's a seed dispenser I found at a Canadian mail order house, Lee Valley: LV Seed Dispenser (Canadian Dollar price). For now I'll use black or dark heavy paper.

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Day 8 update: Aside from continued shifted sleeping, so far all is okay. Today I slept A LOT, 3 am - 4 pm with a few brief awakenings.

 

I do find myself wishing I had reinstated at a lower dose then gradually increasing to an effective dose, e.g. 10 mg. I keep reminding myself "What's done is done."

 

I also wish I had added the tag "Cymbalta" to this thread or used the word in the thread title; I clicked "Submit Post" too quickly. :(

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I also wish I had added the tag "Cymbalta" to this thread or used the word in the thread title; I clicked "Submit Post" too quickly. :(

 

Happy Birthday :)

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Hey Karen, thanks!

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Day 10 update:  I'm doing reasonably well. The only symptom that gets in the way for me is my continued shifted sleep pattern and increased hours of sleep, which started during my skip-days-and-doses period. I had a moment of lightheadedness yesterday. It occurred while I was sitting and had been sitting for more than a few minutes. Weird! I've also had a reduced appetite; I'm satisfied with two meals daily. One nice thing that's happening -- I had started consuming alcohol more frequently during the skip-a-day time; I haven't felt a desire or need for that in the last week.

 

Thoughts to fiddle with my Cymbalta dose continue. Nope -- sticking with the plan. I'm thinking I'll redirect that mental energy into fiddling with -- improving-- what I eat. I'll start with eating more vegetables, working my way up to 4-6 cups/day. I was eating that way 5-6 years ago and felt great.

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A seed dispenser! What ingenuity. Please add this info to Counting beads in a capsule versus weighing
 
You can use melatonin to correct your sleep cycle: Take a small amount (varies by individual) at nightfall and turn off the lights.
 
If you are using the computer late at night, or even a phone, you are reinforcing the wrong cycle. The brain needs darkness to make melatonin properly.
 
Read
 
What is the sleep cycle?
 
Melatonin for sleep: Many people find it helpful
 
TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

and other topics in Important topics about symptoms, including sleep problems

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Altostrata, thanks for your suggestion about melatonin and the links to threads about sleep. I've read them and will try to get my hands on some melatonin today. If my local shops don't offer appropriate doses, i.e. liquid or 1 mg tablets/chewables, my trial will be delayed because I'll be waiting for an online order to be delivered.

 

Although I have no TV, the program f.lux installed on my computer to adjust the brightness and color after sunset as well as a similar program on a tablet, I'll work on finding things other than reading to do before bed and sleep.

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Yesterday I was able to find some well-priced melatonin in split-able 1 mg sublingual tablets (Natural Factors).  I was sleepy yesterday evening and took about 1/4 of a tablet around 8:30 pm.  I was in bed around 9 and asleep not long after. I did wake up at 12:30 and was awake until about 3:30. I took another 1/4 tablet around 2. I slept from about 3:30 to 9:30 am. To quote the inimitable James Brown,  "I feel good."

 

Today and tonight I'll repeat what worked yesterday: a walk outside in daylight hours, 1/4 tablet of melatonin around 8:30 pm.

 

Exciting news -- My seed sower arrived today, just when I took the last pre-counted beads. It looks as if the smallest hole, #1, will be the right size for Cymbalta beads.

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Day 13 of 20mg: I'm really pleased that everything continues to go well.

 

Night 2 of melatonin:  My experience was that I didn't sleep last night, but it feels as if I did. I got out of bed at the same time as yesterday and I'm not tired or sleepy. I took 250 mcg at 20:30, went to bed sleepy at 9 but couldn't sleep. I took another 250 mcg at 01:30.  Tonight I'll either do the same 250 mcg or increase to 500 mcg.

 

Update on Seed sower/dispenser: I couldn't lift the clear plastic lid off so I poured the beads from one capsule through the largest opening (10mm). As usual, my intent was to divide 1 60mg capsule into three 20mg doses.  The first 2 doses went faster than my previous counting method.  With the 3rd, the beads were sticking to the plastic container probably because of the static charge created from shaking the previous hundreds of beads out.  I'll have to figure out a method to eliminate/reduce the charge. Wipe the bottom of it with a damp cloth, maybe? (once I have this figured out, I'll post to the Counting Beads thread)

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Day 13 of 20mg: I'm really pleased that everything continues to go well.

 

Night 2 of melatonin:  My experience was that I didn't sleep last night, but it feels as if I did. I got out of bed at the same time as yesterday and I'm not tired or sleepy. I took 250 mcg at 20:30, went to bed sleepy at 9 but couldn't sleep. I took another 250 mcg at 01:30.  Tonight I'll either do the same 250 mcg or increase to 500 mcg.

 

Update on Seed sower/dispenser: I couldn't lift the clear plastic lid off so I poured the beads from one capsule through the largest opening (10mm). As usual, my intent was to divide 1 60mg capsule into three 20mg doses.  The first 2 doses went faster than my previous counting method.  With the 3rd, the beads were sticking to the plastic container probably because of the static charge created from shaking the previous hundreds of beads out.  I'll have to figure out a method to eliminate/reduce the charge. Wipe the bottom of it with a damp cloth, maybe? (once I have this figured out, I'll post to the Counting Beads thread)

I love the seed dispenser idea! Wish I had thought of that before I bought a digital scale! It sounds like you a doing better. Glad to hear it!

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purcy:  Thanks for stopping by! 

 

Report on seed dispenser: I don't recommend it.  For details, see my post in the counting thread.

 

I took the melatonin too late last night. I missed the window and got to sleep later than previously. Another data point. Aside from that, my other symptoms are stable and manageable/"liveable with."

 

/signature in previous posts in this thread

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I'm feeling wonderful today.  Last night I had a great night's sleep - thanks melatonin and magnesium! 250 mcg melatonin seems to do it for me, ¼ of a 1 mg tablet.

 

A few years ago, I started taking a powdered magnesium citrate product, Natural Calm.  The package recommends dissolving it in hot or warm water. I'm really enjoying the warmth, the lemony flavour and the slight fizz of it before bed. I take ½ tsp Natural Calm, about 100 mg magnesium.

 

Thoughts of accelerating my taper are coming fast and furious.  It occurred to me this morning that doing so might possibly rob me of time feeling well.  The question to ask myself isn't "How soon can I cut the dose?" but "How deep and broad a foundation of stability do I want before my next cut?"

 

/drug and withdrawal history in signature of posts above this one

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'Tis very common to want to accelerate - nice idea to replace those questions with a positive question.  You'll especially want to be careful after that fast Viibryd taper.  Not sure if you saw the link for Tapering Viibryd, but you might be interested to read it regarding common w/d symptoms it can cause.   

 

Glad you enjoyed a good night's rest,

Karen

 

PS The idea of a signature that automatically appears under each post is that we don't need to scroll up all the time to read it. 

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Hi Karen, thanks for the input about the signature. I can see how including my signature is important:  The last signature in the thread is from another member who has tapered off Vibryd and is now tapering Cymbalta and Seroquel.  That's what you responded to. As the kids (used to) say, "My bad." :o

 

Having read several introduction threads, I'm feeling very lucky that I'm only coming off one psych drug and that I'm now having few w/d symptoms.  I do recognize that I may experience symptoms as my taper continues.

 

Last night I could have been asleep by 11:00 or 11:30, but my interest in my reading material pushed me past my melatonin-induced sleepiness window to about 1:30 am.  Yesterday, I got hungry at mid-day, 4-5 hours after breakfast. Returning appetite is a good sign with respect to withdrawal. I'm now feeling well enough to shop for and prepare nourishing food for an additional  meal.

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Whoops :blush: Yes, I did manage to respond to someone else's signature. 

 

Or shall I pretend that I did it on purpose in order to see if you were paying attention?  :)

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What do you mean pretend?  That was your intention all along. Cognitive testing is part of the service, right?

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:D

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Day 14: All continues to go well. Very few, if any, symptoms now. I do notice lower libido, but being widowed and not looking for a relationship a lowered sex drive doesn't interfere with my life or that of anyone else. On the intermittent dosing, I felt, shall we say, more than a bit "antsy." And I notice that my feet are much warmer -- not the nighttime icicles they once were -- with consistent daily supplementation of fish oil, D3 and magnesium. I've had to sleep wearing socks during hot, humid weather!

 

Friday I stopped in at a compounding pharmacy in my neighbourhood to ask about the details needed in a prescription. The pharmacist was great -- he asked lots of questions and had a great recommendation.  If 10% cuts for 3-4 weeks go well, I'll be down to 10 mg in September or October, and am weighing the option of holding there over the winter or slowing my taper to 5% or less until spring. 

 

He asked what doses I wanted; I wrote down a series of 5% cuts -- 10, 9.5, 9.0, 8.6, 8.1, 7.7, 7.2.  His suggestion was to go with 2.5 mg capsules so that I can taper between 10 and 7.5 mg.  This has two advantages:  cost-effectiveness because he's making capsules of a single dosage; and flexibility for me to hold at an intermediate dosage if needed.  The maximum number of beads to count is for 2.4 mg, approximately 22 beads, so fewer beads to count than if I were bead-counting the full dose.

 

He said that I won't be able to count beads from the compounded capsules.  His process is to grind cymbalta beads to powder, weight the dose, mix in filler, and then encapsulate the powder.  As a spreadsheet nerd, I've calculated that I'll have at least 2 foils of 30 mg capsules left then (28 capsules) so I can use those to titrate to intermediate doses between 10, 7.5, and 5mg.

 

The cost for 5 months of 2.5 mg caps (3-4/day) will be about the same as what I paid for 90 days of 60 mg caps. This is only a downside if I compare the amount of drug I get for the money -- the 5-month compounded is about 25% of the mg in 90 days of 60 mg caps. I'm deciding to view it as neutral to positive. I'll be getting what I want and need for a longer period of time, paying about the same amount, and saving time preparing doses.

 

I'm relieved at having some idea about how I'm going to handle my next prescription, or at least having an alternative to the standard 30 mg capsules. The 20 mg caps aren't available in Canada.

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Day 25: I goofed on my last post, that was day 21 not 14. Not sure why my calendar confused me.   Daily melatonin of 250 mcg has eliminated my insomnia and my appetite is back to 3 meals a day.  Since my 2 most noticeable symptoms have stabilized favourably, I'll be making my first 10% cut this weekend, from 20 mg to 18 mg with the intention to hold at 18 mg for 4 weeks, following the SA conservative & cautious recommendations. I'm "kinda, sorta" looking forward to bead counting -- it's fewer beads per dose this time.

 

Seed (bead) dispenser: I gave it another try recently and am more optimistic about its use.  It seems as if the lid problem, that it was extremely difficult to remove, was a one-time issue with a brand new device. The other problem I had was that the shaking the dispenser created static electricity which caused the beads to stick. I may have found a solution to that; after I've tested it a few more times, I'll update here and in the thread about counting beads.

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Day 4 at 18 mg -- So far so good. No new symptoms, re-appearance of previous sx, or aggravation of current sx.

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I'm seeing a fair amount of discussion with newcomers about skipping doses.  I've created a spreadsheet that shows the % concentration decay, comparing daily dose, alternate day dosing and skipping 2 days. This chart is for Cymbalta (duloxetine) or a drug that has a 12-hour half-life.

 

The chart is in a spreadsheet (.xlsx).  I'm going to refine it, maybe showing every 12 hours instead of every 24 and setting it up so that any half-life can be "inputted." Then I'll attach it to another post.

 

The blue line is taking daily doses; green is every other day dosing; red is every 2 days.

post-7196-0-26579000-1464380530_thumb.jpg

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brassmonkey's response to a post I made in Gemingirl's thread

 

" I wish I could blame my anger on psych drug withdrawal and call it a neuro-emotion. Unfortunately I almost always think I have good justification." Scallywag

 

You can, because it is, but that's no justification.  It's a pattern of thinking that I call "the Anger Spiral".  It's very common in normal life and even more so in WD. It goes something like this.  Someones action, real or perceived, momentarily pisses you off.  This triggers a serious of ruminating thoughts that compound that action, blowing it out of proportion and adding to it a lot of supporting emotions dragged up out of your real or imagined past.  It build up and up until there is an explosion of anger.  It feels totally justified because of all the supporting material and the lowered inhibitions caused by the drugs.

 

...   Over the years I have learned about the Anger Spiral and learned to tame it.  The mental training has been much more effective than the drugs ever were.

 

I've definitely had the anger leading to daily compounded ruminations. I absolutely get this.  I had one of these at the end of March.  My outrage at someone's behaviour might be justifiable, my reaction was not:  yelling embarrassing unknown information about that person so that all could hear what an a**hole (I think) she has been and continues to be. It took me at least a week to break the ruminations. 

 

Identifying potential triggers, planning self-protective and non-disruptive responses is something to work on. Thanks for reminding me of this.

 

In my comment (quoted in blue), I was trying to poke a little fun at myself and the human tendency to justify action/inaction very easily.  A wise friend once asked me, "What do you like more: justification or sex?" I said sex.  With humour and great compassion he said, "Really.  How many days have you gone without justifying yourself?"

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This chart is for Cymbalta (duloxetine) or a drug that has a 12-hour half-life.

 

from a couple of posts up.

 

No wonder I always felt so bad when I missed a dose or ran out of a script. That drug is not very forgiving....

 

(btw, thanks for the other sheet, it is working perfectly. You are some excel expert!

 

Edit: You changed the font and I noticed it after I logged out. So when I quoted , it carried over. Took me the whole line to choose every font from the list (except Courier) to see the default is Arial 12 and I knew that once. You actually like Lucida? I'd like to use 'Mistral', looks like my real hen scratches, lol.)

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After rereading your post I can see what you were up to.  I'll chalk it up to having just gotten up.  The anger spiral is something that I want to get out there when ever the opportunity comes up because it's something that will benefit a lot of people.  It goes beyond WD and the concept can be applied to many other situations.

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brassmonkey:  My attempt at humour was weak.  I'll do better in the future. :D

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